Akinyi Brenda, Odhiambo Collins, Otieno Fredrick, Inzaule Seth, Oswago Simon, Kerubo Emily, Ndivo Richard, Zeh Clement
Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Kisumu, Kenya.
PLoS One. 2017 Jun 6;12(6):e0178907. doi: 10.1371/journal.pone.0178907. eCollection 2017.
Herpes simplex virus type 2 (HSV-2) infections are associated with increased risk of HIV transmission. We determined HSV-2 prevalence, incidence and associated risk factors, incidence among persons with indeterminate results, and prevalence of HSV-2/HIV co-infection among young adults (18-34 years) and adolescents (16-17 years) enrolled in an HIV incidence cohort study in western Kenya.
Participants (n = 1106; 846 adults) were screened and those HIV-1 negative were enrolled and followed-up quarterly for one year. HSV-2 was assessed using the Kalon enzyme immunoassay. HSV-2 incidence was calculated separately among HSV-2 seronegative participants and those indeterminate at baseline. Logistic regression was used to estimate the odds of HSV-2 infection and Poisson regression was used to assess HSV-2 incidence and associated factors.
Overall, HSV-2 prevalence was 26.6% [95% confidence interval (CI): 23.9-29.4] and was higher in adults (31.5% [95% CI: 28.3-34.9]) than adolescents (10.7% [95% CI: 7.1-15.3]). Factors associated with prevalent HSV-2 included female gender, increasing age, HIV infection, history of sexually transmitted infection, low level of education, multiple sexual partners, and being married, divorced, separated or widowed. Overall HSV-2 incidence was 4.0 per 100 person-years (/100PY) 95% CI: 2.7-6.1 and was higher in adults (4.5/100PY) and females (5.1/100PY). In multivariable analysis only marital status was associated with HSV-2 incidence. Among 45 participants with indeterminate HSV-2 results at baseline, 22 seroconverted, resulting in an incidence rate of 53.2 /100PY [95% CI: 35.1-80.9]. Inclusion of indeterminate results almost doubled the overall incidence rate to 7.8 /100 PY [95% CI: 5.9-10.5]. Prevalence of HIV/HSV-2 co-infection was higher in female adults than female adolescents (17.1 [95% CI: 13.6-21.0] versus 3.4 [95% CI: 1.1-7.8]).
The high incidence rate among persons with indeterminate results underscores the public health concerns for HSV-2 spread and underreporting of the HSV-2 burden. Careful consideration is needed when interpreting HSV-2 serology results in these settings.
2型单纯疱疹病毒（HSV-2）感染与HIV传播风险增加相关。我们在肯尼亚西部一项HIV发病率队列研究中，确定了18至34岁的年轻人和16至17岁的青少年中HSV-2的患病率、发病率及相关危险因素、结果不确定者中的发病率以及HSV-2/HIV合并感染率。
对1106名参与者（846名成年人）进行筛查，将HIV-1阴性者纳入研究并每季度随访一年。使用Kalon酶免疫测定法评估HSV-2。分别计算HSV-2血清阴性参与者和基线时结果不确定者中的HSV-2发病率。采用逻辑回归估计HSV-2感染的比值比，采用泊松回归评估HSV-2发病率及相关因素。
总体而言，HSV-2患病率为26.6%[95%置信区间（CI）：23.9 - 29.4]，成年人中的患病率（31.5%[95%CI：28.3 - 34.9]）高于青少年（10.7%[95%CI：7.1 - 15.3]）。与HSV-2流行相关的因素包括女性、年龄增长、HIV感染、性传播感染史、低教育水平、多个性伴侣以及已婚、离异、分居或丧偶。总体HSV-2发病率为每100人年4.0例（/100PY）[95%CI：2.7 - 6.1]，成年人（4.5/100PY）和女性（5.1/100PY）中的发病率更高。多变量分析中，仅婚姻状况与HSV-2发病率相关。在基线时HSV-2结果不确定的45名参与者中，22人发生血清转化，发病率为53.2/100PY[95%CI：35.1 - 80.9]。将结果不确定者纳入后，总体发病率几乎翻倍至7.8/100PY[95%CI：5.9 - 10.5]。HIV/HSV-2合并感染率在成年女性中高于青少年女性（17.1[95%CI：13.6 - 21.0]对3.4[95%CI：1.1 - 7.8]）。
结果不确定者中的高发病率凸显了对HSV-2传播的公共卫生担忧以及HSV-2负担报告不足的问题。在这些情况下解释HSV-2血清学结果时需要仔细考虑。
